Background In La Colline Health Care Centre, a resource-poor setting in rural Haiti, the HIV/TB department was faced with low performance in HAART enrollment for eligible HIV patients. HIVQUAL (HIV-Quality) reports generated by our EMR (electronic Medical Record) showed 51.2% ART enrollment for the Oct 2011-March 2012 semester, which further dropped to 33% by May 2012; meaning that 67% of patients who needed treatment during that period, did not receive it. A 5-months Quality Improvement project was initiated, from May to September 2012 to find solutions to that problem.
Methods Quality Improvement methods and tools were used to hasten HAART initiation in eligible HIV patients. The project team used the Ishikawa diagram to evaluate the problem and was able to divide the possible causes into 4 groups: those related to people, to environment, to equipment and to procedures. Using Plan-Do-Study-Act cycles, we considered and tested five interventions. Two of them resulted in most of the improvement: Patient tracking by the community team and obtaining CD4 exam results the same day. Our goal was to reach 80% HAART enrollment within 6 months.
Results Periodic monitoring of the HAART enrollment indicator via EMR’s HIVQUAL report, revelled a progressive improvement in the proportion of eligible HIV patients initiated on HAART; going from 33% to 43.9%, 63.85% and 84.6%, after respectively the second, third and fourth interventions. The project ended in September 2012, with 90.2% of eligible HIV patients, receiving HAART.
Conclusion The staff responded positively to the initiative and the changes. The best impact is for the patients who now can benefit from early access to antiretroviral treatment, thus, avoiding some complications of the disease, which can be fatal. This activity contributed to achieving better health care for our HIV patients and a stronger HIV management system.
- HAART initiation
- HIV treatment
- quality improvement
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